COMPUPIC PURCHASE ORDER / REGISTRATION FORM
I would like a copy of CompuPic!  I understand that I will receive my
own personalized password with which to register the CompuPic(CPIC) 
software, and that by using CPIC agree to all terms of the CPIC
licensing agreement. I also understand that CPIC is protected by
Federal Copyright Laws and International Treaty Provisions, and will
not disclose my password to anyone.  If I operate a BBS, I understand
that the CPIC password is not in the public domain, and cannot be made
available for download for users of my or any other BBS.  I understand
that my correct phone number is required for registration and will be
kept strictly confidential.  Optional items marked with asterisk (*).

YOUR NAME:_________________________________________________________
(PLEASE PRINT)   First Name,  Initial,  Last name

*Company:_____________________________ *Work: (______) ______-________

Addr:_________________________________  Home: (______) ______-________

     _________________________________

     _________________________________

City:_____________________________ State/Prov:_________ Zip:__________

How did you first discover CPIC?______________________________________

------------------------------------------QTY---PRICE----TOTAL---

CompuPic Registration(s)                  ___  $39.95  $_________

__VISA __MasterCard __CHECK ENCL.  (8.25% CA Sales Tax)$_________
                                     -CA Residents Only
__AMEX __Discover
                                                  TOTAL$_________
Credit Card Number:

________/________/________/________ Exp:____/____

Sign:X____________________________________

SEND ME THE COMPUPIC REGISTRATION PASSWORD VIA:

___ E-Mail (CompuServe, AOL, or Internet)..TO:________________________

___ FAX.......FAX NUMBER (incl area code) ____________________________

___ US Mail (to above address)

       ORDERS VIA MAIL                CREDIT CARD ORDERS VIA FAX
  Enclose check and mail to:       Fill out completely and FAX to:
    Photodex Corporation                (510) 449-3519 - FAX
    1781 Barcelona Street
    Livermore, CA  94550               (510) 449-9079 - Voice